Lara DeSanto HEALTH WRITER Oct 20, 2020
If you have hepatitis C, the fun doesn’t stop with one illness. Often, this liver disease is linked to several other health conditions, including nonalcoholic fatty liver disease (NAFLD). Understanding how the two are connected can help you learn the symptoms to look out for, plus the best ways to get treatment if the need arises. We asked the experts for more details about NAFLD and how it’s connected to hepatitis C. These are the need-to-know facts about living with both of these diseases.
What Is Fatty Liver Disease?
As the name implies, fatty liver disease occurs when fat deposits build up in your liver. “The fat in the liver can damage it, causing inflammation and scarring,” explains Rena Fox, M.D., a professor of general internal medicine at the University of California, San Francisco, and a UCSF Health hepatitis specialist. Although doctors still aren’t sure exactly what causes it, NAFLD is linked to obesity, insulin resistance, high blood sugar, and high triglycerides levels.
There are different types of fatty liver disease, but NAFLD is the most common, affecting 30% to 40% of adults in the United States, according to the National Institutes of Health (NIH). While some types of fatty liver disease are linked to heavy alcohol use, people with NAFLD are not over-drinkers.
One of the challenging things about this disease is that it can be hard to detect, since it often has no obvious symptoms until the liver damage is already extensive. “When someone is at a very advanced stage, they may have some pain in the upper-right part of the abdomen, and they may feel tired,” says Dr. Fox. “At a very late stage, they could have fluid in the abdomen, and they could develop yellowing of the eyes and skin. We want to help patients avoid getting to this point.”
There’s also a more aggressive subtype of NAFLD called nonalcoholic steatohepatitis (NASH), which is generally diagnosed via liver biopsy. “Patients with NASH are really at risk for progression of disease,” says Rohit Satoskar, M.D., a transplant hepatology specialist at MedStar Georgetown University Hospital in Washington, D.C. This subtype is less common, accounting for about 20% of people with NAFLD. It’s not clear why some people develop NASH, but if left untreated, NASH can lead to serious health problems like cirrhosis or liver cancer.
The NAFLD and Hepatitis C ConnectionWhy should you care about fatty liver disease if you have hepatitis C? While one condition doesn’t necessarily cause the other, there is an important link. “Even without hepatitis C, patients can have fatty liver disease—they can be separate entities,” says Dr. Satoskar. “However, in patients that do have a hepatitis C infection, there is a higher prevalence of fatty liver disease than in the general population.”
In fact, up to 50% of people with hep C also have fatty liver disease. “We believe that the hepatitis virus itself does something to the metabolism of fats within the liver that can lead to more fat deposition,” he says.
This increased risk might have something to do with your particular strain—or genotype—of hep C virus. “If a patient with hepatitis C has what’s called ‘genotype 3,’ they are a little bit more likely to get fatty liver disease,” Dr. Fox says.
About 20% of people with hepatitis C are infected with genotype 3, according to a 2018 study in Annals of Gastroenterology. And while experts don’t know for sure why genotype 3 leads to fatty liver disease more often than other genotypes, it’s likely related to a unique reaction that occurs between the genotype 3 virus and the cells in the liver that leads to greater expression of fatty acid enzymes. Those with hep C genotype 3 who do get fatty liver disease are also more likely to see the disease worsen faster, leading to liver fibrosis.
Even without this particular genotype, people with hep C can get fatty liver disease for other reasons. “Any hepatitis patient could get fatty liver disease from all of the other conditions that put one at risk,” says Dr. Fox, namely being overweight and having high blood sugar or cholesterol issues.
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